Healthcare Provider Details

I. General information

NPI: 1922315670
Provider Name (Legal Business Name): IBTEHAL JARALLA SHAMLEFFER M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IBTEHAL ABDUL KADEM JARALLA M.D.

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE SUITE 200
GREENSBORO NC
27401-1230
US

IV. Provider business mailing address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-3088
  • Fax: 336-832-3080
Mailing address:
  • Phone: 336-274-3241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2010-01539
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2010-01539
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: